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Orthopaedic surgery in severe bleeding disorders: a low-volume, high-cost procedure
V Mishra1, G E Tjønnfjord, A C Paus
1Health Professional Support Department, Rikshospitalet University Hospital, Oslo, Norway. vinod.mishra@rikshospitalet.no
Summary
Orthopaedic surgery for patients with severe bleeding disorders like hemophilia incurs significant hospital costs. Current reimbursement systems, such as activity-based financing, do not adequately cover these expenses for hemophilia care.
Area of Science:
- Medical Economics
- Hematology
- Orthopaedic Surgery
Background:
- Healthcare systems face increasing pressure to control costs, particularly for high-cost, low-density diseases.
- Accurate assessment of the total cost of care for hemophilia is crucial for justifying patient support and resource allocation.
Purpose of the Study:
- To evaluate the actual hospital costs and Diagnosis-Related Group (DRG) reimbursements for patients undergoing elective orthopaedic surgery.
- To compare the incurred expenses with the revenue generated through the existing reimbursement model.
Main Methods:
- A prospective microcost-analysis method was employed to assess hospital costs.
- Data collection included preoperative, operative, and 1-year follow-up phases, encompassing all direct and indirect costs.
- Nine patients with severe bleeding disorders (hemophilia A, hemophilia B, factor VII deficiency) undergoing 10 major orthopaedic procedures were included.
Main Results:
- The mean hospital cost for orthopaedic surgery in these patients was US$54,201.
- The average actual hospital revenue, including DRG reimbursement and income related to length of stay, was significantly lower at $4,730.
- A substantial deficit was observed between the actual costs and the reimbursement received.
Conclusions:
- Elective orthopaedic surgery for patients with severe bleeding disorders represents a considerable financial burden on hospitals.
- The current activity-based financing system in Norway is insufficient to cover the costs associated with this patient group.
- There is a need for revised reimbursement strategies to ensure adequate financial coverage for hemophilia care, particularly for surgical interventions.